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Sally Tedstone

Breastfeeding Expert Midwife and Breastfeeding Educator with UNICEF UK Baby Friendly Initiative
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Breastfeeding

Breastfeeding thrush

Breastfeeding Thrush is a fungal infection (Candida albicans) that breastfeeding mums and babies can pass between each other. It can be incredibly painful for breastfeeding mums, making nipples sore, cracked and very sensitive. You may see white patches inside babies' mouths. However, breastfed babies don’t always present with white patches as they tend to be much further back in their mouths and can be harder to see. They may have nappy rash and keep pulling on and off the breast during feeds as if in pain. Both Mums and babies will need a short course of anti-fungal treatment.
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In Short
Breastfeeding thrush is very painful and distressing.

Your nipple may appear red and shiny.

If you have darker skin, you may notice the areola is getting paler and losing some of its pigment. You can develop thrush if your baby has thrush in their mouth or nappy rash.

Breastfeeding thrush is more common if you have cracked nipples.

Breastfeeding thrush can occur after taking a course of antibiotics e.g. if you've just been treated for mastitis.

What is (oral) thrush and why does my baby have it?

Oral thrush is caused by a strain of yeast fungus called candida albicans, which lives on the skin and inside the mouths of most people. Normally it’s harmless, but if people are run-down, or their immune systems are weak, it can cause an infection. New babies are still developing their immune systems (especially in the first 8 weeks), so both can be prone to infection. Also sometimes newborns may have picked up thrush during a normal vaginal delivery.

Thrush can also occur after a course of antibiotics when the harmless flora and bacteria that would have kept the thrush at bay have been killed.

You should speak to your doctor or midwife if you think that you have thrush, it is not something you should try to treat on your own. Both you and baby need to be treated at the same time to ensure you get rid of the thrush.

Oral thrush is a common condition, affecting about 1 in 20 babies. It’s most common in babies around in the first 8 weeks of life. Premature babies (born before 37 weeks) are more likely to catch a bout of thrush because of their undeveloped immune systems.

If you baby has oral thrush it might be passed onto you while you are breastfeeding. It can occur after you’ve been treated for mastitis with antibiotics.

You are more likely to have thrush if:

  • Your baby has thrush in their mouth or nappy rash
  • You have cracked nipples that won’t heal
  • You have recently had a course of antibiotics (this allows the opportunistic thrush to spread in the absence of the usual friendly skin bacteria).
  • You are diabetic or if you or your baby has had steroid treatment.
Symptoms of thrush

Symptoms of thrush in babies include:

  • Cottage Cheesy or milky looking deposits in the mouth that don’t come off when you rub them gently. These can often be difficult to see in breastfed babies because of the way babies breastfeed the thrush spots tend to be evident much further back in their mouth.
  • Upset or fussy baby eating.
  • Baby’s saliva with a white shine or a pearly sheen on the inside of baby’s lips.
  • Red or spotty baby face
  • Your baby might have a red sore looking bottom, like a nappy rash.

Symptoms for Mum include:

  • Sore nipples.
  • Deep shooting pains in the breast after feeding.

Thrush on the nipple can mean that you cannot bear to have anything touching your breast, not even clothes. Sometimes the thrush can get into the milk ducts causing deep shooting pains into the breast during and after breastfeeding your baby. Mothers often describe the pain in very graphic terms ‘feeding through broken glass,’ ‘unbearable’ and dread their baby waking up for feeds.

Treatment for Breastfeeding Thrush

Before diagnosing or seeking treatment for Thrush it is important to exclude other causes of nipple/ breast pain so contact your health visitor or breastfeeding counsellor to ensure that your baby is feeding effectively.

Sometimes the thrush will go away on its own after a day or two and the following self-help measures can be tried

  • Acidophilus tablets (from pharmacy or health food store) can help restore helpful bacteria which might have been hampered after antibiotic use
  • Careful attention to hand washing after each nappy change to stop thrush spores multiplying and don’t share personal towels with other family members
  • Thrush thrives in sweet sugary environments so change breast pads often and you could try reducing your sugar intake during an active episode of Thrush.

However, if you think you have thrush and it’s not going away it’s easy to treat so make an appointment with your family doctor.

You and your baby both need to be treated since the infection can be passed back and forth between you.

Your GP may decide to give your baby some antifungal medicine. It’s usually a liquid or gel and you can use your finger or the dropper provided to put the prescribed amount on the affected area. You should be prescribed an ointment to apply to your nipple area as the oral medicine will not work on your breast.

When should I give my baby their medicine?

Follow advice from your GP. It’s usually best to give your baby their oral thrush medicine just after your baby has had a feed or drink.

Once the infection has cleared up, continue to use the medication for another 2 days. If the thrush hasn’t gone after 7 days of continuous treatment, go back to your doctor again for more advice.

The symptoms of thrush – deeper breast pain or nipple sensitivity – are often confused with other things. If you have never had a period of pain-free breastfeeding, your problems are more likely to be connected to positioning and attachment problems than thrush. It’s important to get a breastfeeding assessment from your local support group or local breastfeeding counsellor. They will watch a feed and look at the nipple as it comes out of the baby’s mouth to check it isn’t coming out squashed or misshapen. As well as positioning problems, pain could be caused by a bacterial infection, an allergic reaction or another skin condition. Your doctor may do a swab on the nipple to help identify the cause.

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.